Castro A M, Carmona-Fernandes D, Rodrigues A M, Pedro L M, Santos M J, Canhão H, Fonseca J E
Acta Reumatol Port. 2016 Jul-Sep;41(3):213-219.
An excess in cardiovascular (CV) morbidity and mortality has been recognized in Rheumatoid Arthritis (RA) patients when compared to the general population. Given the paucity of prospective data, our aim was to estimate the incidence of CV events and the contribution of traditional CVD risk factors and RA-related parameters to future events.
Incident fatal and non-fatal CV events (hospitalizations due to unstable angina, myocardial infarction, coronary artery revascularization procedures, stroke, or CV death) were assessed in a prospective cohort of RA women followed since 2007 and without CV events at cohort entry. The presence of traditional CV risk factors, disease characteristics, medication, carotid ultrasound, and biomarkers of inflammation and endothelial activation were evaluated at baseline. Univariate Cox proportional hazard models were used to identify risk factors for CV events.
Among 106 women followed over 565 patient-years we identified 4 CV events (1 fatal stroke, 2 myocardial infarction and 1 unstable angina), which contributed to an incidence rate of 7 per 1000 person-years (95%CI 2.0- 13.9). Patients who developed CV events were older, but the distribution of other traditional CV risk factors was otherwise similar in both groups. Also, corticosteroid dosage and proportion of patients with carotid atherosclerotic plaques was higher in those with CV events. Erythrocyte sedimentation rate (ESR) (HR 1.036; 95%CI 1.005-1.067) and soluble intercellular adhesion molecule-1 (sICAM-1) serum levels (HR 1.002; 95%CI 1.000-1.003) significantly contributed to CV events. These results remained significant after adjusting for patients' age.
We found an incidence of cardiovascular events in women with RA of 7 per 1000 patent-years. This value is similar to that found in other Portuguese cohort of RA patients1 and much higher than the incidence reported for the general Portuguese population. Markers of inflammation and endothelial activation contributed significantly to CV events, but the limited number of events prevents further analysis.
与普通人群相比，类风湿关节炎（RA）患者的心血管（CV）发病率和死亡率更高。鉴于前瞻性数据匮乏，我们的目的是估计CV事件的发生率，以及传统心血管疾病危险因素和RA相关参数对未来事件的影响。
对自2007年起随访的一组无CV事件的RA女性前瞻性队列进行评估，记录致命和非致命CV事件（因不稳定型心绞痛、心肌梗死、冠状动脉血运重建术、中风或CV死亡住院）。在基线时评估传统CV危险因素的存在情况、疾病特征、用药情况、颈动脉超声以及炎症和内皮激活的生物标志物。使用单变量Cox比例风险模型确定CV事件的危险因素。
在随访的106名女性、总计565患者年中，我们确定了4例CV事件（1例致命性中风、2例心肌梗死和1例不稳定型心绞痛），发病率为每1000人年7例（95%CI 2.0 - 13.9）。发生CV事件的患者年龄较大，但两组中其他传统CV危险因素的分布相似。此外，发生CV事件的患者中皮质类固醇剂量和颈动脉粥样硬化斑块患者的比例更高。红细胞沉降率（ESR）（HR 1.036；95%CI 1.005 - 1.067）和可溶性细胞间黏附分子-1（sICAM-1）血清水平（HR 1.002；95%CI 1.000 - 1.003）对CV事件有显著影响。在调整患者年龄后，这些结果仍然显著。
我们发现RA女性的心血管事件发病率为每1000患者年7例。这一数值与葡萄牙其他RA患者队列中的发现相似，远高于葡萄牙普通人群报告的发病率。炎症和内皮激活标志物对CV事件有显著影响，但事件数量有限，无法进行进一步分析。
